Provider Demographics
NPI:1932860863
Name:MEDINA MENA, ARLYN PATRICIA
Entity Type:Individual
Prefix:
First Name:ARLYN
Middle Name:PATRICIA
Last Name:MEDINA MENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 HENDRICKS AVE APT C
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-7025
Mailing Address - Country:US
Mailing Address - Phone:323-629-5136
Mailing Address - Fax:
Practice Address - Street 1:3131 SANTA ANITA AVE STE 112B
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-1369
Practice Address - Country:US
Practice Address - Phone:626-636-2370
Practice Address - Fax:626-453-3415
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15725-RAC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)